Does eczema put my child at risk for infections?

Dermatologist Amy Paller, MD, talks about two infections common in children who have eczema.

Does eczema put my child at risk for infections?

There are two (2) infections that we see quite a bit in our patients with eczema, and they’re both viruses that affect the skin.

Molluscum

It’s quite common to see a disorder called molluscum in our patients with eczema.

Molluscum appears as a small bump that can grow with time, and usually no more than the size of a pencil eraser. Molluscum can often be identified in that they are somewhat dome-shaped and they have often a central core that is white. So parents can identify these.

[Molluscum] can often spread rapidly. They tend to have a predilection for areas where the eczema occurs.

And really they’re more of a nuisance than anything else. They’re not easy to get rid of. They seem to come back. New ones often develop even after successful treatment with physical agents in the doctor’s office.

Because this can go on for a while — until the immune system kicks in, which can take several months, but sometimes takes a few years — these molluscum often pop up in multiple areas of the skin.

We know that molluscum in themselves often tend to led to molluscum dermatitis, particularly in children with sensitive skin and eczema. That means that one can see more eczema right around the molluscum themselves, so it becomes a vicious cycle. Molluscum love the dry red skin of eczema and create them themselves.

Parents often worry when a [molluscum] lesion turns bright red and has a pus-containing area within it that means secondary infection. In fact we often reassure parents that that is not infection but rather the immune system finally trying to kick in and clear the molluscum. So that can be a very good sign.

How do we treat molluscum? There are a variety of ways, all of which are physical. With children who have eczema, we sometimes will use an oral medicine called cimetidine. It’s very low risk, but it really tastes very bad. And it’s hard to get children who are young and require that liquid medicine (they cannot swallow a pill) to take the dosage of cimetidine that is required — 40 mg per kilogram per day. [Cimetidine must be] taken twice a day for a 3 month course.

[Cimetidine] can be quite helpful, and in a motivated family with a cooperative child, it is something to consider.

Otherwise we’re using techniques like application of cantheratin, which can be applied very carefully and specifically to each molluscum. [It] will create a small blister at the site and subsequently lead to flattening of those lesions.

In other cases, we sometimes need better control. We may get that by very carefully and very locally applying a little bit of liquid nitrogen to the site. Or sometimes even after application of a topical antiseptic, [we can] scrape lesions. There are other ways to treat as well, but those are what we use most commonly.

Herpes virus

The other virus that we see on the skin with increased prevalence in eczema, and particularly in those children who have moderate to severe eczema, is herpes. In fact, children can get eczema herpeticum, in which the herpes spreads with a predilection for occurring on the skin in those areas with the eczema. This is sometimes confused with bacterial infection.

But indeed we need to recognize herpes infections. We need to treat them with oral acyclovir, a very, very benign medicine but one that is very important in clearing the eczema herpeticum or just straightforward herpes infections in children with eczema.

And in fact, in children who have recurrent herpes infections — particularly more than 3 times a year — we sometimes introduce chronic administration of the acyclovir. A daily single dose — for periods of let’s say 6 months at a time — can very much help to control those episodes safely.